week 1 optional learning objectives

Question 1

What controls the synthesis of RBCs in the bone marrow?

Answer 1

Synthesis of RBCs in bone marrow is controlled by erythropoietin (EPO) produced in the kidneys.

Question 2

Where is erythropoietin (EPO) produced?

Answer 2

EPO is produced in the juxtaglomerular apparatus of the kidney’s afferent arterioles.

Question 3

What are reticulocytes?

Answer 3

Reticulocytes are immature red blood cells that retain some protein synthesis capabilities.

Question 4

Where do reticulocytes live before becoming mature RBCs?

Answer 4

Reticulocytes live in the bone marrow for ~3 days and finish maturing in the peripheral blood for one additional day.

Question 5

What is the lifespan of a mature RBC?

Answer 5

The lifespan of a mature RBC is 110-120 days.

Question 6

What are key aspects to investigate in a patient’s history when assessing for anemia?

Answer 6

Key aspects include dietary habits, medications, chemical/toxin exposure, family history, previous blood tests, and bleeding history.

Question 7

What symptom onset might indicate anemia due to rapid blood loss?

Answer 7

Patients with rapid blood loss will have more severe symptoms due to less time for the body to adapt.

Question 8

Name three common symptoms of anemia.

Answer 8

Fatigue, muscle weakness, and headache.

Question 9

What is Koilonychia and which type of anemia is it commonly associated with?

Answer 9

Koilonychia is spoon-shaped nails, commonly seen with iron deficiency anemia.

Question 10

What is the normal reference range for hemoglobin (HGB) in adults?

Answer 10

The normal range varies, but generally <13 g/dL in men and <12 g/dL in women is considered anemic.

Question 11

What does MCV stand for and how is it categorized in anemia?

Answer 11

MCV stands for Mean Corpuscular Volume and is categorized as normocytic (80.0-100.0 fL), microcytic (<80.0 fL), and macrocytic (>100.0 fL).

Question 12

What does MCHC stand for and what does it measure?

Answer 12

MCHC stands for Mean Corpuscular Hemoglobin Concentration and measures the ratio of hemoglobin mass to RBC volume.

Question 13

What does a high MCHC indicate?

Answer 13

High MCHC (>36 g/dL) can indicate spherocytosis, and is sometimes seen in sickle cell anemia and hemoglobin C disease.

Question 14

What is anisocytosis?

Answer 14

Anisocytosis is the variation in the size of red blood cells, often seen in anemia.

Question 15

What does a peripheral blood smear test for?

Answer 15

A peripheral blood smear tests for abnormalities in the morphology of red blood cells.

Question 16

What are acanthocytes, and what do they indicate?

Answer 16

Acanthocytes are spherical cells with thorny projections, often seen in severe liver disease, abetalipoproteinemia, and post-splenectomy.

Question 17

What are echinocytes (burr cells), and what conditions are they associated with?

Answer 17

Echinocytes are spiculated red cells associated with liver disease, uremia, and pyruvate kinase deficiency.

Question 18

What do codocytes (target cells) indicate?

Answer 18

Codocytes indicate hemoglobinopathies, thalassemia, obstructive liver disease, or post-splenectomy.

Question 19

What are dacryocytes (teardrop cells), and what do they suggest?

Answer 19

Dacryocytes are elongated RBCs with a pointed end, suggesting myelofibrosis or severe hemolysis.

Question 20

What are Howell-Jolly bodies, and when are they seen?

Answer 20

Howell-Jolly bodies are DNA remnants in RBCs, seen in patients with splenectomy or functional asplenia.

Question 21

What does a bone marrow biopsy involve?

Answer 21

A bone marrow biopsy involves aspiration of liquid bone marrow for examination, often used in cases of severe pancytopenia or suspected bone marrow infiltration.

Question 22

What is the first step in the workup of microcytic anemia?

Answer 22

The first step is to rule out iron deficiency anemia using tests like ferritin, serum iron, and TIBC.

Question 23

What is the definition of microcytic anemia?

Answer 23

Microcytic anemia is defined by an MCV (Mean Corpuscular Volume) of less than 80 fL.

Question 24

What conditions are associated with increased levels of reticulocytes in microcytic anemia?

Answer 24

Conditions include hemorrhage, hemolysis, and thalassemia.

Question 25

What causes sideroblastic anemia?

Answer 25

Sideroblastic anemia is caused by a failure to incorporate heme into protoporphyrin, leading to defective hemoglobin synthesis.

Question 26

What conditions are often responsible for macrocytic anemia?

Answer 26

Common causes include B12 and folate deficiencies, liver disease, hypothyroidism, and certain medications.

Question 27

What is megaloblastic anemia, and what are its causes?

Answer 27

Megaloblastic anemia is characterized by macro-ovalocytes and hypersegmented neutrophils, typically caused by B12 or folate deficiencies.

Question 28

What are the symptoms of vitamin B12 deficiency?

Answer 28

Symptoms include paresthesia, decreased proprioception, spasticity, and altered mental status.

Question 29

What are the causes of anemia of chronic disease?

Answer 29

Causes include chronic infections, cancer, autoimmune diseases, and diabetes mellitus.

Question 30

What are the lab findings in anemia of chronic disease?

Answer 30

Lab findings typically include low serum iron, high TIBC, normal or high ferritin, and low reticulocyte count.

Question 31

What are the different types of hemolysis?

Answer 31

Hemolysis can be microcytic, normocytic, or macrocytic and can be immune-mediated or non-immune mediated.

Question 32

What is the role of the Direct Coombs test in anemia?

Answer 32

The Direct Coombs test detects the presence of antibodies or complement on RBCs, indicating autoimmune hemolytic anemia.

Question 33

What is the treatment for warm antibody hemolytic anemia?

Answer 33

Treatment includes corticosteroids like prednisone, and in some cases, splenectomy or rituximab.

Question 34

What are the signs of anemia related to jaundice?

Answer 34

Jaundice, particularly scleral icterus, can indicate hemolysis.

Question 35

What can thyromegaly indicate in the context of anemia?

Answer 35

Thyromegaly may indicate hypothyroidism, which can be associated with anemia.

Question 36

What is the significance of lymphadenopathy in an anemia workup?

Answer 36

Diffuse lymphadenopathy can indicate malignancy.

Question 37

What does an enlarged spleen suggest in anemia?

Answer 37

An enlarged spleen may indicate chronic malignancy or portal hypertension from chronic liver disease.

Question 38

What is the significance of low MCHC (<32.0 g/dL)?

Answer 38

Low MCHC typically indicates hypochromic anemia, often associated with conditions such as iron deficiency.

Question 39

What is the primary treatment for vitamin B12 deficiency?

Answer 39

The primary treatment is B12 replacement, either orally or via injection.

Question 40

What are basophilic stippling cells associated with?

Answer 40

Basophilic stippling is associated with lead poisoning and thalassemia.

Question 41

What does an elevated reticulocyte count (>3%) suggest in the context of anemia?

Answer 41

An elevated reticulocyte count suggests a response to blood loss or hemolysis.

Question 42

When should a transfusion be considered in hospitalized patients with anemia?

Answer 42

Transfusion is considered in hemodynamically unstable patients or those with hemoglobin <7 g/dL in the ICU.

Question 43

What does a high RDW typically indicate in anemia?

Answer 43

A high RDW is commonly seen in reticulocytosis.

Question 44

What are target cells on a peripheral smear indicative of?

Answer 44

Target cells are indicative of conditions such as thalassemia, hemoglobinopathies, and liver disease.

Question 45

What is the significance of a positive Direct Coombs test?

Answer 45

A positive Direct Coombs test indicates autoimmune hemolytic anemia.